Parts Unknown

October 5, 2013 5:25 AM

A trip to the ER for Leslie Lagerstrom's teenage son, Sam, becomes even more stressful because of the lack of cultural competence on behalf of his medical providers.

Unfortunately, Sam's experience is not unique.

HRC's guide to the LGBT community for Emergency Responders

Central Texas Transgender Society: Going to the Emergency Room

Previously on Metafilter: #transdocfail

posted by roomthreeseventeen (13 comments total)

This article seems to be victimization in search of a story.

I assume someone along the way must have brought him up-to-speed, but unfortunately I am wrong. The doctor begins to examine Sam’s abdomen during which time the fact comes up that Sam is transgender. With that revelation, he quickly removes his hands from Sam’s body, as if he has received an electric shock. Looking completely surprised, he admits out loud, “I’m not up-to-speed on those issues – do you still get a period?”

We might have been able to laugh at this question too if it wasn’t so humiliating. There was no bigotry or maliciousness in the question, but that didn’t make it any less difficult to hear.

Someone admits that they don't know something, author gets 'humiliated'. We teach people that's it's okay to admit to not knowing something but here the author gets huffy when someone asks for their assistance.

They have an extremely low bar for what constitutes 'humiliation' and come across as a terrific pain in the ass to deal with.
posted by Setec Astronomy at 5:38 AM on October 5, 2013 [14 favorites]

I'm caught between feeling bad for Sam and his mother, and feeling like they're looking to be upset that the world doesn't understand transgender people properly yet.

Doctors are people, too, and transgender people, especially at 17, are not a dime-a-dozen. The system isn't built for it yet, but being humiliated and angry just doesn't seem like the right answer, I guess?
posted by InsanePenguin at 5:44 AM on October 5, 2013 [3 favorites]

They have an extremely low bar for what constitutes 'humiliation' and come across as a terrific pain in the ass to deal with.

Or maybe they are so incredibly tired of having to face and fight these issues on a daily basis. Expecting medical providers to be aware of transgender's needs is not too much to ask, really.
posted by Foci for Analysis at 5:44 AM on October 5, 2013 [4 favorites]

A lot of the confusion seems to stem from the mother talking for her son, instead of letting him speak for himself. Understandable, maybe, but not very helpful.

Also, it's never a good idea to lie to people trying to treat you.
posted by HFSH at 5:47 AM on October 5, 2013 [2 favorites]

I was going to say exactly that, Setec. That seems like an eminently sensible question to me.

Or maybe they are so incredibly tired of having to face and fight these issues on a daily basis. Expecting medical providers to be aware of transgender's needs is not too much to ask, really.

Asking if he has periods is not actually being unaware of transgender needs, actually. That doctor had no way of knowing to what degree Sam had undergone transition. If the doctor had assumed that Sam did not have functioning ovaries and his abdominal pain was cause by, say, an ectopic pregnancy, Sam could have flat out died.

I am all for cultural competence; I cannot support using it as an excuse not to ask legitimate, respectful questions necessary to provide competent medical care.
posted by LittleMissCranky at 5:54 AM on October 5, 2013 [14 favorites]

They have an extremely low bar for what constitutes 'humiliation' and come across as a terrific pain in the ass to deal with.

Every parent wants their child to be accepted and treated as well as everybody else, so it's understandable on one level. But yeah, everything's filtered through a pissed-off agenda that makes the blog largely read as a narcissistic "Everybody's a troglodyte." She has opportunities to increase understanding, but she opts for indignant, which just helps ensure that the people she deals with leave with further suspicion and negative attitude towards the transgendered. In this case, she could have left the staff thinking "a transgendered person came through and it wasn't such a big deal."

But that's not my kid, so I have no idea if I'd have that kind of foresight in a world of slights.
posted by Mayor Curley at 5:55 AM on October 5, 2013 [1 favorite]

I want to point out one thing: all patients are asked the same set of questions by each round of medical personnel as they are cared for in a medical setting. This is how medicine works. The patient interview is an important part of the process - a part that the patient often finds annoying because they are repeating the same information to multiple people. I know I've been annoyed that the person holding my entire medical records is asking me things that are already written there.

Was this unpleasant for Sam and his mother? Yes. And I think that it is crappy that he and she have to go through this especially in an already stressful situation. That said, his transgender status is extremely relevant to his medical care and it would be bad if at any point in the process of diagnosis, it were not known.

I hope Sam is feeling better after his appendectomy and that the people who interacted with him all went home and did some reading so the next time will be easier for the patient and the medical professionals.
posted by sciencegeek at 5:57 AM on October 5, 2013 [1 favorite]

I think to me the most harrowing piece of the article is the nurse after the surgery who mimes "penis" with her hand. There are ways to be get information without being rude.
posted by roomthreeseventeen at 5:59 AM on October 5, 2013 [3 favorites]

"A woman wearing white orthopedic shoes, which seem premature given her young age..."

What is the appropriate age?
posted by parki at 6:01 AM on October 5, 2013 [4 favorites]

Pretty harsh reaction, people. There's not really any need to call them names, is there? Yes, some of the questions they got were surely necessary/reasonable, but that doesn't mean the manner they were asked and the general bedside manner of the staff she was dealing with was respectful, tactful, or informed/well-trained. Is it really so unreasonable for her to explain the feelings of embarassment-slash-offence that this caused? Or to expect better from medical professionals? I don't think so.
posted by Drexen at 6:02 AM on October 5, 2013 [2 favorites]

The loud subtext of this seems to be "Even though I run a trans parenting website, I feel really uncomfortable talking about my son's transitional status in person, so I lie or speak very vaguely, creating unnecessary complications, and then get upset when medical personnel have not successfully read my mind."
posted by Pater Aletheias at 6:26 AM on October 5, 2013 [7 favorites]

Hey, all nurses wear orthopedic shoes. You try working on your feet for a 12 hour shift in heels.

So we're gonna have the usual newsfilter/outragefilter party, but let's leave trashing nurses for being insufficiently fashionable out of it, huh?
posted by spitbull at 6:29 AM on October 5, 2013

...but that doesn't mean the manner they were asked and the general bedside manner of the staff she was dealing with was respectful, tactful, or informed/well-trained.

Did you read the article? I've read it over and over, and I can't for the life of me find any instance of the medical staff acting disrespectful or tactless. Strip-away her jaundiced and snide asides, and simply read what the medical staff say and do. It's all pretty normal, appropriate stuff, including admission by medical professionals that they aren't experienced with this type of patient. The only disrespect I read in that article comes completely from the author.

I can certainly sympathize with any parent of a trans teen, and the enormous challenges that must create for them in everyday life. That said, this piece starts with a sequoia-sized chip on her shoulder, which only gets larger and larger with each paragraph.

Trans teens represent a vanishingly miniscule portion of the population, and I suspect most doctors and nurses will go their entire careers without ever encountering one. It's unfortunate, but being the parent of a trans teen means you are also going to bear the weight of educating those whom you come into contact with, including medical staff. The weight doesn't get any lighter by toting the huge chip around with you, though.
posted by Thorzdad at 6:32 AM on October 5, 2013 [3 favorites]